RESUMO
Purpose: This retrospective study aimed to assess the effects of two differing revision total knee implants designs (condylar and rotating hinge) on joint line height. Method: The use of distal augmentation and pre and post revision radiographic joint line heights were compared in 19 condylar type knee replacements (Zimmer NexGen Legacy Constrained Condylar Knee - LCCK) and 40 LINK-Endo-rotating hinge knee replacements. Joint line and patellar heights were determined for each implant using four validated methods. For comparison within a group a two tailed paired Student's t-test was used, for comparison between the groups an unpaired, two tailed Student's t-test was used. A p value of less than 0.05 was deemed statistically significant. Results: In 15 of 19 NexGen revision knee replacements distal augments were used. No distal augments were used in the LINK-Endo RHK group. In both systems there was no tendency to elevate the joint line relative to the tibia. The joint line was distalised relative to the femur in the NexGen group and proximalised in the rotating hinge knee group. Measurements using antero-posterior radiographs were found to be the most reliable method of assessing joint line height when compared to lateral radiographs. Conclusion: Both revision knee implant systems adequately restored joint line height. In condylar type knee revision implants elevation of the joint line height may be avoided through the use of distal augmentation. We found AP radiographs to be the most reliable method of accurately assessing joint line height.
RESUMO
STUDY DESIGN: Presented is a case report of a 16-year clinical course of a patient with a multiple myeloma of the third cervical vertebra. OBJECTIVE: To describe a rare 16-year follow-up of a cervical multiple myeloma lesion that forced several surgical interventions. SUMMARY OF BACKGROUND DATA: Multiple myeloma is a systemic malignancy. It slowly causes bone destruction due to bone marrow infiltration. It is more common in the elderly and rarely affects the young. In patients with continuing neck pain and headache, one has to bear in mind the rare possibility of multiple myeloma or also other malignancies affecting the cervical spine. MATERIALS AND METHODS: Clinical case analysis, radiographs, magnetic resonance images, and histological sections of the lesion are discussed. Repeated surgical interventions were required due to progressive disease. RESULTS: Initial surgical treatment was aimed at palliation. However, this was in contrast to the slowly progressive clinical course. Thus, further surgical interventions were necessary. The patient died 16 years after the first procedure due to progression of the disease. CONCLUSION: Even in young patients presenting with neck pain and minor neurological symptoms, one should bear in mind the rare possibility of multiple myeloma. At the very least, a radiograph of the cervical spine and a routine blood test should be performed. Surgical interventions must take into account the relatively long period of survival in multiple myeloma patients compared to patients with other secondary bone tumors.